In Reply Dr Weeks raises important points about limitations of our article and interpretation of results.

First, there are many possible explanations for our findings. Dr Week’s assertion that veterans are not solely reliant on the US Department of Veterans Affairs (VA) for primary care services is a notable concern. This suggests that our measure of continuity of care may be incomplete due to care received outside of the VA. When an outside primary care provider (PCP) completes a quality measure, such as a cancer screening, it must be transmitted and recorded in the VA electronic health record. But we have no measure of the continuity of care received outside of the VA. If veterans received more continuous care outside of the VA, the correlation between continuity and ambulatory quality could be higher than we estimated.